.
T

he United States has been invested in global health institutions such as the WHO and UNAIDS for decades, yet has frequently fallen short of hoped-for population health returns. Fragmented aid, complex procurement regulations, and a lack of long-term strategy all contribute to these failures. While monetary hurdles exist, we argue that the biggest hurdle is one of vision. At home and abroad, the US has a long track record of treating health as a commodity rather than an essential element of democracy. We argue this is the biggest strategic failure of the last fifty years of U.S. domestic and foreign policy. Looking forward, the US should broaden the concept of health to include climate, sustained socioeconomic improvement, and a functional political class to ensure that the political and economic gains of the twentieth century will continue for future generations.

Democracy’s Independent Variables

The last four U.S. Administrations State Department Strategic Plans emphasized healthy populations, democracy, and freedom. This is because these variables correlate with economic growth and political rights around the world. It then follows syllogistically that when opposite conditions are present, a local infection in a Chinese province can turn into a global pandemic. Despite rhetoric on global health investments, one need look no further than the USAID organizational chart to see that global health is less than 7% of the agency’s allocated budget. Such scant global health funding is surprising given how the lack of public health infrastructure contributed so greatly to multiple surges of global COVID-19 infections. This anemic approach also ignores the HIV/AIDS crisis just three decades ago, which was so devastating to developing countries that at one point, fighting it consumed half the annual budget of Zimbabwe. 

From Policy to Practice

Even before India peaked at over 4,000 COVID-19 deaths a day, its socioeconomic and public health challenges set the stage for the pandemic to devastate its population. India is not alone. Many of its South Asian neighbors face similar challenges and their citizens have shorter than average life expectancies. These population level challenges cannot be addressed by increasing healthcare capacity or funding alone.

For example, more hospital beds and healthcare workers will help treat cases of tuberculosis but would not address the underlying malnutrition and abject poverty that fuels its spread. Also, antibiotics can treat diarrheal diseases that claim the lives of over 100,000 children annually but does not fix the root problem of unhealthy drinking water. This raises larger questions. What policies can be crafted upstream to lower the risk of these diseases downstream? What policies can address the decreased crop yields that result in malnutrition or the runoff of animal waste that pollute the well water? 

Donor countries and aid organizations have a solid track record of addressing the end stage illnesses and deploying rapid diagnostics and treatments to plug recurrent holes in the health problems in many developing countries. What is frequently missing is a strategy to connect the root causes of these problems to their downstream effects of people being less healthy and less able to fully participate in their democracies. Global health programs that only focus on health and U.S. foreign and domestic policy that do not tie poor health to the negative externalities, thus failing to truly solve the problem. Framing Health as essential to freedom, however, could make the connection much more tangible in peoples’ and policy makers minds.

Treating health in its broadest sense—as the optimization of one’s relationship and ability to interact with her environment and community—would create a mandate for countries and organizations to focus on root causes of disease to prevent future public health crises. This could give advocacy groups around the globe the rhetorical ammunition to demand action from their governments on those things that negatively affect their health—from pollution to poor government services.

In the case of India and its neighboring countries, an example of such a policy could be for the U.S. and partner countries to couple healthcare capacity funding with measures to reduce carbon emissions over the near term, crop resilience programs, and access to clean water. All such funding could be linked to trade agreements that incentivize regional over global trade, with broad latitude and economic support given to programs that reduce carbon emissions. Local and regional trade of goods could be incentivized to help reduce carbon emissions.  Lowering carbon emissions, ensuring clean drinking water, increasing crop yields all help to reduce future health problems. The novelty of this approach—tying so many aspects of economic development to health outcomes—is one of many reasons it would be difficult to implement. However, the traditional approach—U.S. agencies and institutions providing funding for specific diseases, time periods or categories (e.g., to improve midlevel training or HIV/AIDS testing in developing countries), while beneficial, has not been broad enough for us to ensure the continued promotion, sustainment, and guarantee of our health and ability to exercise our freedoms.  

A Healthy Conclusion

The journey to a better, sustainable future begins with one step. The first step here is garnering the collective courage to reimagine our health as something much larger than accessing a healthcare system when we are sick. We should collectively reimagine our health as our freedom and recognize its dependence on our environment, our communities, our climate, and our safety. This approach accepts health as an essential component of our ability to fully participate in a democracy.  The path forward is clear; where our policies and initiatives at home and abroad are not aligned with that reality, we restructure them.  We cast aside the shackles of false freedom and work as individuals, communities, activists, and public servants to tackle the multiple upstream problems we cannot ignore; problems that are making us less healthy and less free. The goal should be for us to have solved so many of the contributing factors to poor health that our perennial shortage of healthcare capacity will no longer exist; and quite possibly neither will our need for healthcare capacity at all.

About
Kermit L. Jones
:
Dr. Kermit Jones is a former White House Fellow and current candidate for Congress in California’s 4th Congressional District.
About
Maya Kahwagi
:
Dr. Maya Kahwagi is a family practice physician and geriatrician who has worked in Lebanon.
About
Neel Vahil
:
Neel Vahil is a 4th year medical student at New York Medical College.
The views presented in this article are the author’s own and do not necessarily represent the views of any other organization.

a global affairs media network

www.diplomaticourier.com

Health Is Freedom

Photo by Sean Stratton via Unsplash.

December 10, 2021

Old models of treating good health outcomes as ensuring access to health care systems have been a major strategic failure for the U.S. and other donor countries. Reimagining health as intrinsically tied to our environment and community - and as a core concept in freedom - is the way forward.

T

he United States has been invested in global health institutions such as the WHO and UNAIDS for decades, yet has frequently fallen short of hoped-for population health returns. Fragmented aid, complex procurement regulations, and a lack of long-term strategy all contribute to these failures. While monetary hurdles exist, we argue that the biggest hurdle is one of vision. At home and abroad, the US has a long track record of treating health as a commodity rather than an essential element of democracy. We argue this is the biggest strategic failure of the last fifty years of U.S. domestic and foreign policy. Looking forward, the US should broaden the concept of health to include climate, sustained socioeconomic improvement, and a functional political class to ensure that the political and economic gains of the twentieth century will continue for future generations.

Democracy’s Independent Variables

The last four U.S. Administrations State Department Strategic Plans emphasized healthy populations, democracy, and freedom. This is because these variables correlate with economic growth and political rights around the world. It then follows syllogistically that when opposite conditions are present, a local infection in a Chinese province can turn into a global pandemic. Despite rhetoric on global health investments, one need look no further than the USAID organizational chart to see that global health is less than 7% of the agency’s allocated budget. Such scant global health funding is surprising given how the lack of public health infrastructure contributed so greatly to multiple surges of global COVID-19 infections. This anemic approach also ignores the HIV/AIDS crisis just three decades ago, which was so devastating to developing countries that at one point, fighting it consumed half the annual budget of Zimbabwe. 

From Policy to Practice

Even before India peaked at over 4,000 COVID-19 deaths a day, its socioeconomic and public health challenges set the stage for the pandemic to devastate its population. India is not alone. Many of its South Asian neighbors face similar challenges and their citizens have shorter than average life expectancies. These population level challenges cannot be addressed by increasing healthcare capacity or funding alone.

For example, more hospital beds and healthcare workers will help treat cases of tuberculosis but would not address the underlying malnutrition and abject poverty that fuels its spread. Also, antibiotics can treat diarrheal diseases that claim the lives of over 100,000 children annually but does not fix the root problem of unhealthy drinking water. This raises larger questions. What policies can be crafted upstream to lower the risk of these diseases downstream? What policies can address the decreased crop yields that result in malnutrition or the runoff of animal waste that pollute the well water? 

Donor countries and aid organizations have a solid track record of addressing the end stage illnesses and deploying rapid diagnostics and treatments to plug recurrent holes in the health problems in many developing countries. What is frequently missing is a strategy to connect the root causes of these problems to their downstream effects of people being less healthy and less able to fully participate in their democracies. Global health programs that only focus on health and U.S. foreign and domestic policy that do not tie poor health to the negative externalities, thus failing to truly solve the problem. Framing Health as essential to freedom, however, could make the connection much more tangible in peoples’ and policy makers minds.

Treating health in its broadest sense—as the optimization of one’s relationship and ability to interact with her environment and community—would create a mandate for countries and organizations to focus on root causes of disease to prevent future public health crises. This could give advocacy groups around the globe the rhetorical ammunition to demand action from their governments on those things that negatively affect their health—from pollution to poor government services.

In the case of India and its neighboring countries, an example of such a policy could be for the U.S. and partner countries to couple healthcare capacity funding with measures to reduce carbon emissions over the near term, crop resilience programs, and access to clean water. All such funding could be linked to trade agreements that incentivize regional over global trade, with broad latitude and economic support given to programs that reduce carbon emissions. Local and regional trade of goods could be incentivized to help reduce carbon emissions.  Lowering carbon emissions, ensuring clean drinking water, increasing crop yields all help to reduce future health problems. The novelty of this approach—tying so many aspects of economic development to health outcomes—is one of many reasons it would be difficult to implement. However, the traditional approach—U.S. agencies and institutions providing funding for specific diseases, time periods or categories (e.g., to improve midlevel training or HIV/AIDS testing in developing countries), while beneficial, has not been broad enough for us to ensure the continued promotion, sustainment, and guarantee of our health and ability to exercise our freedoms.  

A Healthy Conclusion

The journey to a better, sustainable future begins with one step. The first step here is garnering the collective courage to reimagine our health as something much larger than accessing a healthcare system when we are sick. We should collectively reimagine our health as our freedom and recognize its dependence on our environment, our communities, our climate, and our safety. This approach accepts health as an essential component of our ability to fully participate in a democracy.  The path forward is clear; where our policies and initiatives at home and abroad are not aligned with that reality, we restructure them.  We cast aside the shackles of false freedom and work as individuals, communities, activists, and public servants to tackle the multiple upstream problems we cannot ignore; problems that are making us less healthy and less free. The goal should be for us to have solved so many of the contributing factors to poor health that our perennial shortage of healthcare capacity will no longer exist; and quite possibly neither will our need for healthcare capacity at all.

About
Kermit L. Jones
:
Dr. Kermit Jones is a former White House Fellow and current candidate for Congress in California’s 4th Congressional District.
About
Maya Kahwagi
:
Dr. Maya Kahwagi is a family practice physician and geriatrician who has worked in Lebanon.
About
Neel Vahil
:
Neel Vahil is a 4th year medical student at New York Medical College.
The views presented in this article are the author’s own and do not necessarily represent the views of any other organization.